The Institution of Engineering and Technology

CEng/IEng Professional Registration

Application Form
V7. February 2011
A Your Details
Title First ame Family ame
!ost ominals "ate of #irth
""$%%$&&&&
'ome Address

(ounty$)tate !ostcode (ountry
'ome !hone %obile 'ome Email
!referred Venue for Inter*ie+
ame of !rofessional ,egistration Ad*isor -!,A. -if applicable.
Please specify your gender: %ale Female
B Current Employment
Employer /ob Title
#usiness Address
(ounty$)tate !ostcode (ountry
#usiness !hone #usiness Email
Which address ould you li!e all correspondence sent to" 'ome #usiness

C Your Interests
What are your area#s$ of interest" -tic0 all that apply.1
(onsumer Electronics Transport (ontrol Electronics IT %anufacturing %echanical Engineering
!o+er %anagement (ommunications (onstruction$#uilding )er*ices
D %em&ership
In order to apply for professional registration' you ill first need to &e a mem&er of the IE()
I +ish to apply to become a %em&er of the IET
I am already a %em&er of the IET

%embership umber1
!age 1 of 7
The Institution of Engineering and Technology
CEng/IEng Professional Registration
Application Form
V7. February 2011
E Registration
Please indicate &elo hich category of registration you ish to apply for:
Incorporated Engineer -IEng. (hartered Engineer -(Eng.
!age 2 of 7
* Education
)tart "ate End "ate (ourse$2ualification Title Educational Establishment (lassification FT$!T$)3$
"istance 4earning
+ Professional De,elopment or (raining -chemes #if applica&le$
)tart "ate End "ate (ompany Accreditation number -if applicable.
. Professional -er,ices' Papers Presented etc)
"ate Title
I Accounta&ility Diagram
!age 5 of 7
/ Rele,ant Career .istory
)tart$End
"ate
Employer 6 /ob Title E7perience
!age 8 of 7
ote1 The information pro*ided abo*e +ill be used to carry out an initial assessment of your application. As a result of this
initial assessment you may be re9uired to pro*ide further information to support your application.
0 Declaration
I declare that the statements made on this form are to the best of my 0no+ledge true. I agree to comply +ith the ,oyal (harter
and #ye:la+s and ,ules of (onduct of the Institution of Engineering and Technology -IET. and understand that this is a
commitment to beha*e ethically +ithin my profession. I +ill do my best to promote the interests of the IET. I confirm that I ha*e
not committed any offence of +hich the IET +ould re9uire me to gi*e notice under its ,ules of (onduct.
I understand and consent to the information pro*ided on this form being processed by the IET and the Engineering (ouncil for
registration purposes. I also understand and consent that the information +ill be used by the IET and any of its associated
organisations for the purposes of promoting; deli*ering and impro*ing my e7perience of the IET; its products and its ser*ices; by
post and electronic means.
The ,ules of (onduct and the ,oyal (harter and #ye:la+s are published on the +ebsite +++.theiet.org$byela+s .
)ignature of (andidate "ate
1 -upporters2 Details
3e; the undersigned; support the candidate from personal 0no+ledge; as a person +orthy of consideration for Engineering
(ouncil registration and +e endorse the correctness of this form.
-upporter 3 -mandatory.
ame
-print.
)ignature
-sign.
"ate
Address for communication
!ostcode !hone Email
E( ,egistration type -if applicable. e.g. (Eng; IEng %embership of Engineering Institutions e.g. %IET; FIET
%embership umber -if applicable.
-upporter 4 -mandatory.
ame
-print.
)ignature
-sign.
"ate
Address for communication
!ostcode !hone Email
E( ,egistration type -if applicable. e.g. (Eng; IEng %embership of Engineering Institutions e.g. %IET; FIET
%embership umber -if applicable.
!age < of 7
-upporter 5 -optional.
ame
-print.
)ignature
-sign.
"ate
Address for communication
!ostcode !hone Email
E( ,egistration type -if applicable. e.g. (Eng; IEng %embership of Engineering Institutions e.g. %IET; FIET
%embership umber -if applicable.
6otes for -upporter#s$ 7 #efore signing the application form; you are re9uested to ensure that the presentation of the form is to
the candidate=s best ad*antage and pro*ides ade9uate information to enable the IET to reach a decision. !lease note you +ill be
re9uired to complete an In9uiry Form on the candidate=s eligibility for registration.
Return this form together ith the appropriate fee to: Registration 8 -tandards Department' %ichael *araday .ouse' -i9
.ills Way' -te,enage' .erts' -+3 4AY' :0
!age > of 7
The Institution of Engineering and Technology
CEng/IEng Professional Registration

(hec0list
.a,e you: Yes/6o
1. ,ead the guidance notes document on ho+ to complete your application.
2. (ompleted all sections of the form clearly in #4A(? in0 and on +hite paper only -colour and
grey become unreadable +hen copied and should not be used..
5. Enclosed a copy of your further or higher education certificate-s.; signed by one of your
)upporters as a true copy of the original.
8. (learly mar0ed your position on the Accountability "iagram in )ection I; and put the dates you
held that position.
<. )igned the "eclaration.
>. (hec0ed that your )upporters comply +ith the re9uirements as detailed in the guidance notes.
7. @btained the signatures of your )upporters and re9uested them to complete an In9uiry form.
A. Enclosed the appropriate application fee +hich is payable to the Institution of Engineering and
Technology.
B. ,etained a copy of your application.
Please send your completed form and payment to:
(he Institution of Engineering and (echnology
Registration 8 -tandards Department
-te,enage
.ertfordshire
-+3 4AY
:0
!age 7 of 7